In Colorado, the market has changed dramatically since we made the decision to put in Meditech. We have seen Epic become the predominant system, where before there was a hodgepodge. Meditech probably had the most, but it was a hodgepodge of vendors.

As we’ve looked and seen Epic come into Sisters of Charity, University, Poudre Valley, Memorial, etc., it gave us pause before we made a decision to go to 6.1. Should we continue to invest with Meditech, who’s been a great partner with us, or should we look at alternatives? We decided that before we commit that much money, let’s look at alternatives.

We made a decision that Epic offered great benefits for the community and Colorado. We have providers that go between the various health systems. Having familiarity with the go-between hospitals was a plus. Same with nursing. Then for the residents of Colorado, the Epic sharing is huge. We felt that gave the residents an extra safety component as well. Those were drivers that went into our decision.

What strengths and weaknesses do you see of Epic versus Meditech?

One of the challenges we had with Meditech was in the ambulatory space, the old LSS product. As you probably know, Meditech is completely rewriting that ambulatory product. What we have seen so far looks very good. But it’s new and we need a solution now in that ambulatory space. That is something we see as a plus with Epic.

The other thing we saw with Epic was some functionality that Meditech either does not have yet or is on their roadmap. Anesthesia is one that comes to the top of my mind. Epic has that in place. Those are some benefits we see.

We also see the benefits of being able to share Epic content with health systems. Not just locally, but nationally, and some pretty well-known health systems around clinical content. It’s not sitting in a room trying to reinvent the wheel.

Did Meditech encourage you to interact and share content with fellow customers?

No, they did not. It wasn’t that they discouraged us, it just wasn’t something that they did. We didn’t go into it with that as a primary focus, but coming out of it, that had a lot of appeal.

The final thing for us is that we have eight affiliate hospitals. We have a lot of hospitals approaching this that are not affiliates yet, saying, “Can you manage my IT?” While we were going down that road with Meditech, the Community Connect program that Epic has that’s already a formal program was just another little piece of icing on the cake to help us make that decision of where we want to go as an organization — providing IT services, EMR, etc. This would jump-start those efforts for us.

Was cost or achieving return on investment a concern?

We’re a values-based organization. One of our values, of course, is stewardship. We like to say that in any decision of this magnitude, you’re going to have tension in the values.

Certainly yes, there was tension around, “We are going to increase our costs. We’re going to make a significant investment in putting in Epic.” But we felt it was in the long-term best interest of the ministry for a variety of reasons that I’ve described. We felt this was the direction we needed to go. The board agreed and approved it and here we go. Now the fun starts.

Did you consider Cerner?

We did look at Cerner. As you may or may not know, Centura is a joint operating agreement between Catholic Health Initiatives and Adventist Health out of Florida. We seriously looked at Cerner with the idea that we could piggyback on the work that Adventist Health has done and that could jumpstart our implementation.

In the end, our providers were really more comfortable with Epic. It was overwhelming support for Epic. Not so much that there was anything wrong with Cerner — it was just the situations I described that pushed Epic to the forefront.

How have you done with Meaningful Use and how will Epic change your plans?

We’ve attested for Stage 1 for all of our hospitals except a brand new hospital that’s in the measurement period right now. We are in our first measurement period for Stage 2 and we’re running into a couple of challenges.

One is that when we started, there were two physicians in the entire state of Colorado that had a Direct address, so we’ve been scrambling to help get providers signed up. Then Meditech’s patient portal got deployed in February. We’ve been scrambling to get people pushed to the portal on the acute side.

We feel like we’ve made a lot of good traction there. Our next timeframe that we can measure will be July through September 30. We have to make it then. I’m cautiously optimistic we will hit that. It’s been a big push with our CEOs of our hospitals.

Where do you think the Meaningful Use program will end up, or where do you hope it will?

That’s a great question. I hope we will achieve the goals of connectedness, meaning transitions of care between providers, between levels of care, become much better. I hope it doesn’t become so hard that more people decide “I’m done” and opt out.

I know the government is struggling to find that fine line of, “I just don’t want to hand out free money and everyone gets a participation trophy. I have a goal I want to achieve, but if I make it too hard, no one will participate.” That’s my fear, that we’re going to see more people just decide this is too challenging and opt out. Then all the foundation work we’ve done may be didn’t achieve what we hoped.

Do you think that would be a bad outcome? The idea was to get EMRs installed, which happened in Stage 1, and not giving out more money wouldn’t change that. It would let vendors and providers go back to their own agendas.

I don’t necessarily think it would be a bad thing, meaning we wouldn’t have just wasted all this money. What I worry about is, in healthcare, we tend to be slow to take initiative at times. It’s like we built the house, but we didn’t quite finish it. Would we go ahead and finish it? Would we go ahead and really work hard to make it better for transitions of care? Would we do all that on our own if there’s neither carrot nor stick? That’s what I worry about.

The adage is that the carpenter never finishes his own house. Would we do that? I’m all for not just continuing just to hand out money, but let’s at least stay at the table and have conversations and make it meaningful to get this finished.

What questions or concerns did you have about interoperability when you selected Epic?

Certainly it was a concern. Their comment back is, “We do more sharing than any other system.” Of course you look at it and it’s a lot of Epic-to-Epic sharing.

I would say, because of our experience with Meditech — which was traditionally been somewhat similar to what Epic’s been accused of as far as challenging to get information out to share– that we said it’s going to be a challenge and we’re going to have to address it. But we also feel like that they have to respond with the CCD. They’ve got to hit all the requirements of Meaningful Use.

I would argue that there probably isn’t really any EMR that is plug-and-play to share clinical information in a meaningful way yet. We’ll address the challenges as we come up against them.

The other party Epic was a bit late to was analytics, but they are moving with that. What are you doing or what are you looking for in terms of analytics and population health management?

We started down that road with Explorys for doing some population health. We have Explorys and Verisk tied in with them, tied in with some other products.

We are probably a little late to the party ourselves as far as robust data warehouse. That’s the direction we’re going. But we recognize, great that we can get this Epic data or in today’s world this Meditech data and we can analyze it, but that’s only a subset of all the data we need to analyze to get a whole picture of the patient or of the system of care, anything. We need to tie that together. Not just Centura’s data, but we have the Centura Health Neighborhood, our clinical integrated network with a couple thousand of affiliated physicians all using various EMRs that we need to tie into our systems as well.

We’ve got a lot of work to do on data analytics, as does healthcare in general. I know we’re not in alone in talking with my counterparts about how we solve this problem.

Hospitals use Epic as a competitive weapon to a certain extent, offering it to owned and affiliated practices who can’t afford and support it on their own. That also gives the health system access to their data. Do you think your physicians will be concerned about Epic differently than LSS?

No. It’s amazing. We’ve already been approached by several physicians asking if they can get on Epic with us. There’s a lot of excitement in our community around the fact that we’re bringing in Epic.

In terms of innovation, are you doing anything that would be considered risky or offbeat or using smaller companies that few people would have heard of?

A lot of our time has been spent recently on making the Epic decision. But the work we’ve been doing with population health with this integrated network I described, so that’s where Verisk and Explorys come in.

We did some innovative stuff this year with our health plan firm associates. Innovative for our area, not necessarily nationwide or outside of healthcare. But we did the tobacco testing, the biometric screening. If you didn’t meet certain criteria, your premium went up. If you met it, you got a discount on the premium. You had opportunities to do wellness activities that could help you earn points for lower premiums as well.

To measure all that, we used CafeWell and brought all that data from the biometric screening, everything, into CafeWell. It was Year One. We certainly learned things that we will do different in Year Two. But that’s been a pretty interesting change for our associates. We’ve talked about wellness now for years, but now it impacts me and my house and my dollars if I don’t do what I need to do health wise.

You oversee non-IT services such as supply chain and recruiting, a different span than the average health system CIO has. How does that make you see IT differently from someone who just runs the IT organization?

To give you some background on that, I’m the non-traditional CIO. I never worked in IT until I came to Centura. I’ve done project management and some software packages, but I was never a traditional IT person. My background is primarily revenue cycle and finance in healthcare.

Centura was going to outsource the IT department. I was asked to do the financial model with the outsourcing company, representing Centura to get this deal done. Then it became evident that the model didn’t make sense, it wasn’t going to work here. We did a reorg of the IT department. Then I was asked if I would consider staying. I fell in love with the organization, so here I am as the CIO.

We finished the Meditech implementation. We had a new CEO come in, Gary Campbell, who’s still our CEO. He was doing his talent evaluation and reorg, looked at my background, and was intrigued by it. He wanted to create a structure that separated what he calls “corporate” from “service center.” Corporate would be things like finance or his office, where I’m dictating down to the organization a policy or setting strategy. He defined service center as these are services that the hospitals, the physicians, the organization, are "purchasing" — and I put purchasing in air quotes because they’re paying through their management fee — purchasing these services from the service center. That would include IT, supply chain, revenue cycle, and departments like that.

He said, “As I’m creating that, I need someone to oversee this service center.” That’s how that came about. He said, “You know, your background lends well to overseeing these areas.” Here I am six years later still overseeing them. It’s been a very educational opportunity for me.

Where it helps me is that because of my background, I came in and I somewhat understood the organization from a non-IT perspective. But now when you also have operational oversight for these departments, it gives you more views into the organization from different perspectives than you would get just being the CIO. You get clinical from lab and you’re seeing clinical and cost savings from supply chain. It’s very helpful. I think it also helps the leaders of those areas because they get different perspectives from me as well because of the diversity of what I’m overseeing.

Do you think other organizations will do the same thing in putting someone with no IT background in charge because it’s really not that important any more that they have programmer or infrastructure experience?

I think so. It’s not going to be something that happens overnight. There’s still a lot of people that say, when it comes down to making that hiring decision, I need that person that understands the IT infrastructure because I don’t. Because you think about who’s doing the hiring — it’s usually a CEO, COO, CFO — and they traditionally don’t have any IT background. They’re concerned, “If I put that non-traditional person in place, is that going to come back to bite me? Because I need someone that really understands it.”

I think more progressive organizations will move there. They’re going to see that if I get the right leader, they can get a good CTO, they can get the right people in place. I need them to understand the strategy in how IT can enable us to move that strategy forward, versus well, we got a new generator, that’s exciting. But I think it will be a long, long road.

My other concern with that is, how do you keep your talent inside of IT excited and not leave to go outside of healthcare where maybe there’s an opportunity for them to move to VP or CIO or something else? Because if they see that inside of healthcare it’s going to be going to more operational people than IT people, I need to go somewhere else to advance. You have to tie it back to the mission and why we’re here and keep them focused and excited on that as well as creating opportunities for advancement for them.

What do you see as your biggest challenges and opportunities in the next few years?

Certainly cost is always going to be a challenge. We’ve made a decision to put in Epic and that will drive up our costs, but how do we find other areas where we can generate efficiency, hold cost down or minimize the increases as we in this industry get a wake-up call on our cost structure? That is one.

How do we support the organization in identifying opportunities outside of IT’s budget for cost reduction? How do we get the analytics in their hands fast enough so they can identify opportunities and move on them? Those are both opportunities and challenges.

I think the other opportunity we have is as an organization is this implementation of Epic. We did a lot of standardization when we put in Meditech. We were probably more a federation of hospitals than a health system. Putting everyone on a common platform, the same universe of Meditech, forced a lot of standardization. Then we’ve continued down that road with the ambulatory implementation, the home care, putting out CPOE. We’ve moved more and more people to trying to do things together.

I think we have a wonderful opportunity with the new implementation to take that to the next level. Our users are much more sophisticated than they were six years ago because they’ve been using an AMR for six years. They know the challenges they’ve had and the things that have worked really well for them. We know we have to reduce clinical variation even further to drive out cost. This gives us an opportunity to have those discussions with our providers. It’s also the opportunity to further drive standardization and revenue cycle, etc., where we can do even better as an organization.

This is an opportunity. We have to be very careful not to just re-implement an EMR and check the box that we got it done and then figure we’ll optimize and do everything later. We need to seize the opportunity while we’re implementing to refine what we’ve already done and make it even better.

Do you have any final thoughts?

Thank you for what you do. I got turned on to your site back when we announced Meditech. Someone said, “Do you read HIStalk? You guys are on there.“ I don’t think I’ve ever missed an article since. Thank you for all the hard work because I can only imagine how much time this consumes of you and your team. You do great things, so thank you.

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Currently there are "12 comments" on this Article:

Good article. It sounds like Dana’s org is doing this for all of the right reasons. My question is self serving; is Dana’s org going to use EPIC’s patient accounting and billing system? If so, how does he and his org rate it? It is okay, just okay, excellent, etc. One of the ways to reduce cost is to have an efficient billing solution that has everything built-in. You never hear much about EPIC’s rev cycle solution. Why is that?

Interesting read. I like hearing differing perspectives on the CIO position from those not cut from the traditional cloth.

The one bullet that was mentioned was regarding the Meditech Patient Portal. Now I know that adoption is probably less than what they really want it to be, but has Dana, or any other CIO going through the process of transitioning vendors, given thought to how a patient might experience a change from Meditech’s platform?

The UI has to be different, and how does that equate to growing the existing adoption? Perhaps I am splitting bytes.

Epics is just an EMR . Switching from Meditech to Epic is not to improve outcomes or cost. A true continuum of care platform is an after though for every existing EMR vendors including Epics. Installing an EMR in every facilities is repeating the silo mentality . A true collaboration platform should be something similar to a SAP model. None of the existing EMRs are designed to be patient centric.

It is just an EMR, but I think you underestimate the value proposition of being able to see basic clinical activity like labs and notes on a patient across the outpatient and inpatient settings. That is still a very big win for many organizations in this country. I worked with 10+ organizations that had disconnected systems between the hospital and ambulatory worlds and the ability to see that basic information alone built significant goodwill.

Over the past 8-10 years this country has really just learned to walk in regard to data access in the continuum of care setting. Some groups are starting to run, but the vast majority are still learning to walk, but as they say, you have to learn to walk before you can run.

The critical service lines are not even connected…I agree with ei, that the HIS players must stretch themselves to either tightly integrate the data coming from diagnostic and preoperative service lines, or none of this will ever scale to a usable acquisition engine. Spend big money for document management tools, and then when you ask for Data it comes back broken or incomplete. I am becoming more and more amazed that these products that sit on top of old Hierarchical Database tools dominate our health systems. Can we ever even walk?

“I am becoming more and more amazed that these products that sit on top of old Hierarchical Database tools dominate our health systems.”

Before you complain a lot about “old Hierarchical Database”, please take a look at which other industries use the same database. A quick search will reveal that the same database (Cache) is also used extensively in financial world as well as European space agency.

Doesn’t Jimmy John’s also run on an M box? as fast as your order is delivered is as fast as their code runs. Please note though: both Epic and Meditech run a more classic version of Intersystems, but to cache’s credit (and intersystems in general) it does offer vertical and horizontal scaling and additionally “on your deathbed, you will receive total consciousness.” So its got that goin’ for it, which is nice.”

“I am becoming more and more amazed that these products that sit on top of old Hierarchical Database tools dominate our health systems.”

Is some alternative being proposed? Don’t the complex data models of healthcare map better to hierarchical models than relational models?

I’m assuming at this point that Epic and others have explored this issue regularly, and would shift to something else if they saw some kind of financial advantage or needed to overcome a technical barrier. I doubt they stick with this because it looks great next to their vinyl record collection.

This is a fundamental misunderstanding. Healthcare is neither more nor less complex than any other industry, barring weird corner cases that you could find literally anywhere. And the weird corner cases collectively would form no pattern worth talking about.

People who lack training in database fundamentals don’t understand the following. In databases, there is relational and then there is everything that came before. Relational databases brought academic rigour (via mathematical set theory), a clear statement of the issues that were most important (via ACID), and a standard to measure progress against (via Codd’s 12 rules).

Replacing one relational database with another is difficult. Replacing a hierarchical database with a relational database is a nightmare and could sink the company. Worst of all, what is the likely outcome of the first release of the new version with the new database? You’d typically get no new user functionality. The job of replacing the database would consume all your development resources.

These healthcare vendors have been skilled at either not talking about these issues, or claiming that these archaic technologies are actually advantages. I say “these healthcare vendors” because Epic isn’t the only one.

Why doesn’t HISTalk just come out and say that they hate MEDITECH? This sad excuse of an aricle is yet another example of their “shoddy journalism” where they try to paint MEDITECH in a negative light. The questions were clearly tainted to provoke negative answers towards MEDITECH. Fortunately Dana did not fall into their trap. One can take from the article that Dana – and Centura by proxy – where disappointed with MEDITECH and thus began a search for another vendor, yet Dana provided classy answers that did not degrade MEDITECH but did show that another option was available and ultimately chosen.

Full disclosure: I have managed two healthcare systems in the past that were running MEDITECH (MAGIC and Client/Server) and was overall pleased with the systems and integration. Today I managed a healthcare system running Epic. I have to admit that I do not seem much of a difference but would jump at the chance to go back to MEDITECH if for no other reason than their service beats Epic’s every single time.

And finally…HISTalk, MEDITECH is ALWAYS spelled in all caps. Should we review to you as histalk?

[From Mr. H] For a bit of fuller disclosure, the IP address of this comment suggests that it’s from an executive of a Meditech-only consulting company who always complains about anything I write about Meditech that isn’t flattering (such as the company’s published sales and net revenue numbers). I acknowledge that many folks in the industry have an emotional or financial investment in any company I write about, but that interview was from 18 months ago and I don’t think asking a question about a system change is biased. I’ve learned that just mentioning a company’s name is the same as waving a red cape when an overly defensive bull is anxiously looking to charge at something.

Meditech and other companies can refer to themselves any way they want, but the AP Stylebook for journalists is clear: “”Do not use all capital letter names unless the letters are individually pronounced: BMW. Others should be uppercase and lowercase.” The commenter’s own Boston newspapers correctly write it as “Meditech,” just like they write “Athenahealth” instead of the company’s uncapitalized version. In that regard, I would be happy to accept “Histalk” as correct under those same rules.

As a longtime contributor to Tim’s HIStalk, I can tell you that this medium has attracted a broad audience from all aspects of the healthcare universe. It is definitely not biased, and plays no favorites that could slant its editorial content!

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